A partnership with

Department of Health West

Midlands demonstrating

significant health outcomes

21st

September 2010

Childhood Obesity

The West Midlands

Consortium

Today’s agenda

• Update on MEND’s national data

• West Midlands Consortium Outcomes

• Benchmarking Outcomes

• Updates and Developments

Research and Evaluation

Clinical trials

Feasibility Study 2002-

2003

Pilot 2004-2005

UK RCT 2005-2007

UK Rollout 2007-9

2nd UK RCT &

population level

analysis 2010+

Australia RCT

2010+

US RCT 2011+

Efficacy Trial:

UK RCT (2005-7)

RCT: Significant improvements at 3 and 6 months; maintained at 12 months

Sacher et al. Obesity. 2010

From Efficacy to

Effectiveness Trials

UK rollout data (2007-9)

• Children: 9,754

• Girls: 55%

• Minorities: 23.4% (UK: 7.9%)

• Single parents: 33% (UK: 24%)

• SES: 48% don’t own home (UK: 31%)

• Mean age: 10.4 (±1.7) years

• Mean BMI z-score: 2.8 (±0.6)(UK %) = UK national average

UK locations

Data cleaning

Potential number eligible for inclusion:

9754 children

Data discarded on following criteria:

• Height and weight outliers

• Outliers for psychometric measures

• BMI outliers

• Age (out of range, no age, got younger!)

• Program dates (within a specified time)

Total with valid pre- and post data at 3 months:

6815 (70%)

BMI

Waist circumference

Changes in Primary Outcome Measures

BMI

27.5

26.7

20

21

22

23

24

25

26

27

28

Before MEND After MEND

BM

I (k

g/m

2)

Mean difference = -0.8 kg/m2

p<0.0001

27.4

26.6

Waist circumference

86.9

84.2

70

72

74

76

78

80

82

84

86

88

Before MEND After MEND

Wais

t cir

cu

mfe

ren

ce (

cm

)

Mean difference = -2.7cm

p<0.0001

86.8

84.1

Physical activity

Sedentary behavior

Cardiovascular fitness

Psychological symptoms

Changes in Secondary Outcome Measures

Time spent in physical activity

Mean difference = 3.8 hours/week

p<0.0001

10.9

14.7

0

2

4

6

8

10

12

14

16

18

Before MEND After MEND

Ph

ysic

al

acti

vit

y (

ho

urs

per

week)

Time spent in sedentary behaviours

Mean difference = -6.2 hours/week

p<0.000116.9

10.7

0

2

4

6

8

10

12

14

16

18

20

Before MEND After MEND

Sed

en

tary

acti

vit

y (

ho

urs

per

week)

Cardiovascular fitness

Mean difference = -9.1 beats/minute

p<0.0001110.2

101.1

60

70

80

90

100

110

120

Before MEND After MEND

Re

co

ve

ry h

eart

ra

te (

be

ats

pe

r m

inu

te)

Psychological Symptoms (SDQ)

13.4

10.2

0

2

4

6

8

10

12

14

16

Before MEND After MEND

To

tal

dif

ficu

ltie

s (

ran

ge 0

-40)

Mean difference = -3.2

p<0.0001

West Midlands Consortium

Results

• Timeframe: September 2008 – August 2010 (23 months)

• Number of programmes: 29

• Number of children confirmed: 212

• Mean age (yrs) for the group: 10.5 (± 1.8)

• Number of children with pre- and post data: 154 (73%)

Overview

DH West

Midlands

Programme

Locations

DHWMC results

* = p≤0.0001DHWMC

results*

MEND national data*

BMI (kg/m²) -1.0 -0.8

Waist circumference (cm) -2.2 -2.7

Days doing physical activity (per week)

1.2 1.3

Physical activity (hours/week) 3.2 3.8

Sedentary activities (days/week)

-4.7 -6.2

Recovery heart rate (beats per minute)

-6.0 -9.1

Total difficulties score (0-40) -3.5 -3.2

Nutrition score (0-28) 6.6 6.5

Programme attendance, retention

and BMI SDS change

Feasibility RCTUK

roll-outDHWMC

n 11 117 6566 154

Mean

attendance (%)78 86 78 80

Drop-outs (%) 9 3 13 12

90% of children reduce their BMI z-score after

MEND 7-13

External Evaluation:

DH West Midlands

Standard evaluation framework

(SEF) criteria

• Child obesity rates above national average

• Worcester University evaluated 7 local CWMPs

Evaluation summary

Carnegie Fun4Life

Fitter Families

GOALS MEND One Body One Life

Watch It! YW8?

Cost per participant

£300 £396-423 £500-600 £510 £236 £669 £203

BMI change

-0.1 (0.3%

decrease)

-0.1 (0.2%

decrease)

No change -0.9 (4.4%

decrease)

-0.4 (1.7%

decrease)

+0.3 (1.1%

increase)

-0.7 (2.5%

decrease)

Waist Circumference change (cm)

-0.8 (0.9%

decrease)

Not collected

-7.1 (7.1%

decrease)

-2.3 (2.6%

decrease)

+2.1 (2.7%

increase)

+0.5 (0.6%

increase)

Not collected

Self esteem change

NA NA NA +3.4 NA +0.2 +1.7

Evaluation conclusion

• MEND and Watch it were the only 2 programmes with

peer reviewed evidence

• They concluded “MEND appears to offer good value

for money in terms of benefits to weight status,

psychosocial functioning and behaviour change.”

Health economics and wellbeing

evaluation

Independent study found:

• The ICER of the programme is £1,671 per QALY

gained, considerably below the NICE threshold for

cost-effectiveness of £20k-£30k

• The programme creates health and social outcomes

with a combined total value of £3,831 - £5,331 per child

• The study concludes that MEND 7-13 is a cost

effective and cost saving intervention which provides

returns on public investment of 967% -1331%

Y O R K

Health Economics

C O N S O R T I U M

Benchmarking to improve performance

Average number of children per program = 11 (22 participants)

Delivering community-based

programmes is complex

Data systems

and processes

Program

resourcesProgram

development

Data systems

development

Skills of

delivery teams

Change in skills ofdelivery team

+

PartnershipsPartnership

development

Program

implementation

Delivery teams

Hiring delivery

teams

+

+

++

Quality

+

+

Measuredoutcomes on

health

+

Selectivity of

partners

+

Performance

goals

Performance

gap

-

+

+

Gap in health

outcomes

Goal in health

outcomes

+-

-

Teams needed

to implement

program

Local team

staffing gap

-

+

+

R2

Programinnovation

B1

Qualityassurance

R3

Partnershipdevelopment

R1a

Data systemsinnovation

B2

Inexperience

B3

Hiring

R4

Humanresources

-

B4

Disruption

Budget

Funding+

+

+

-

Expenses

+

R1b

Data systemsinnovation

Hovmand P, Huang T, Finegood D et al. The

MEND Systems Map. In preparation. 2010

Updates and Developments

• Programme updates: MEND World, MEND Mums

• Publication updates: 26 peer-reviewed papers and

abstracts

• Awards: (CMO awards)

• Training: e-learning

Range of prevention and

treatment programmes

open to all

children

targeted towards overweight and obese childrenin pilot

phase

facilitated

self-help

programme

MUMS

Celebrating success

• 1st DH rollout of a CWMP

• Directly improved the health of 212 participants

• Very positive and highly statistically significant health and

psychosocial outcomes

• Overcame early barriers to achieve good attendance and

retention

• Cross-sector partnerships led to improved delivery

• Trained over 185 frontline health and exercise

professionals to deliver, manage and refer to programmes

• Creation of a solid foundation will lead to even greater

success in the future

Thank you

Thank you!

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